Variance analysis of acute myocardial infarction clinical pathway in the Era of national health insurance

Acute myocardial infarction (AMI) was responsible for 7.4 million deaths worldwide and could cause complications, disability, productivity loss with high cost. Since Indonesia has implemented the National Health Insurance, cost efficiency in maintaining clinical practice quality is needed. Clinical pathway is a tool for maintaining quality of clinical process and cost by setting intervention based on time and sequence. Analysis of variance was carried out to evaluate the implementation of clinical pathway. Data from medical and billing record were reviewed and analyzed by Clinpath Evaluation Tool version 2.0. Characteristic of patient, average utilization of medical treatment and clinical tests, and drugs utilization were obtained from this tool. Hospital has played a good role in maintaining quality of health services. This can be seen from the accordance between clinical practice and clinical pathway in majority of the medical treatments and drugs administration. Average length stay was 4.65 days with the median of 6 days, and this was close enough with clinical pathway. Administration of oxygen and isotonic fluid were the highest average utilization in clinical practice. Nitrate and anti-platelet were the major drugs used in medication. Wide variations only occurred in laboratory tests (variation: 86.96%) and should be evaluated, considering variation could affect quality of services and moreover on the cost of treatment.